Myintegrativehealth Blog – Adrenal Fatigue – Natural Hormone Therapy – Thyroid Dysfunction – Pain Relief – Digestive Health

Could something you take every day disrupt your sex life?  Absolutely! Medications are one of the most common libido killers.   When these meds are prescribed or taken over-the-counter, most people don’t consider how they might affect us outside of the condition they are targeting.  We usually just want symptom relief and blame our low sex drive on stress, a bad mood and even our partner.  And while these are all important pieces of the puzzle, do not overlook the drugs that you take every day.

According to a report from the Institute for Healthcare Informatics, the top ten most prescribed drugs are:

Wow!  6 out of 10 of the most prescribed medicines decreases libido in men and women!

So which ones are the culprits?  Let’s start with the cholesterol-lowering medication Zocor.  This class of drug also includes two of the top 10 selling drugs:  Lipitor and Crestor.  Cholesterol is the backbone of all our hormones; therefore it makes sense that anything that lowers cholesterol will lower our hormone production.  A 2010 study showed men prescribed statin drugs had lower testosterone levels and erectile dysfunction.   Testosterone is required for sexual arousal so anything that inhibits it will likely reduce your sex drive.

Opiate analgesics such as hydrocodone, oxycontin, and codeine have been shown to lower testosterone and are linked to erectile dysfunction in men.  Blood pressure medications such as Lisinopril, Norvasc and Hydrochlorothiazine (HCTZ) are notorious for causing erectile dysfunction in men.   Metoprolol is another commonly used anti-hypertensives linked to a decreased interest in sex.

Serotonin, a neurotransmitter in the brain, is manipulated by a class of drugs called SSRIs.  These are commonly used to treat anxiety and depression.  Serotonin is responsible for regulating sexual behaviors such as erection, orgasm and ejaculation.  However, high serotonin levels will decrease sex drive.  A common side effect of SSRIs, which        are designed to increase serotonin levels, is decreased libido.

In addition to these commonly prescribed meds, over the counter medicines like antihistamines such as Benadryl can disrupt your sex life.  Just as antihistamines dry up allergy-induced sinus congestion, they dry up or decrease vaginal lubrication thereby decreasing sexual interest and pleasure.

Birth control pills cause a drop of in a woman’s libido.  They increase the production of a protein called sex hormone binding globulin.  This protein binds to hormones but has an affinity for testosterone.  When testosterone binds to this protein, the body cannot use it.  Ironically, even though many women take birth control for the freedom to have sex without getting pregnant, the pill actually lowers a woman’s interest in having sex.

This list is just the tip of the iceberg.  Unfortunately there is a very long list of drugs that disrupt your libido.  If you think your meds may be affecting your sex life, please talk to your doctor.  Never just stop taking a medicine because you don’t like the side effects.  Your doctor may be able to switch you to a different medication or help you make lifestyle changes that allow you to withdraw from the drug under supervision.

So often people begrudge initiating change because of perceived obstacles such as travel or holidays.  I’ve learned that it is really not that hard to stay healthy on the road!

Thriving on the go:  3 Key Steps
Ok, you’re taking care of yourself and getting healthier.  You’ve worked out some good habits and healthy routines in your daily life.  You’ve probably learned that it is easy to lose momentum and drift back to unhealthy habits.  Whether you’re going across the globe, or over the river and through the woods, don’t let travel do this to you!

Think of your health as drawing energy from 3 main sources:  your sleep, your exercise and your diet.  If you can keep these sources working for you, you’ll be OK.

Sleeping on the go.  Nothing ruins your memory of a good trip like the lingering bronchitis you picked up on the flight home.  What is the main reason this happens?  Your immunity was down from lack of sleep.  When you’re traveling, you want to take it all in and you have time zone changes to deal with.  Put these factors together and our bodies really need as much or more sleep than normal, not less.

• Start scheduling the week before traveling; shift your sleep schedule towards your new schedule as much as possible.  This works best when you are moving your sleep schedule forward.
• Avoid sleep at your destination until it is your bedtime in local time.
• Avoid alcohol and caffeine the day of travel.
• Adults can use 2-3mg of time-released melatonin at bedtime during short trips and the first few days back home.  This resets your internal clock.

Exercise on the go.  How do you workout when you can’t get to the gym?  Easiest answer is do lots of walking.  Fortunately this is easy whether you’re going to an amusement park, beach or most other parts of the world.  You can also get an good workout with simple body weight exercises.  Here is a great link to a page with 20 amazing exercises you can do anytime and anywhere.  P.S.  If you’re a climber, you can always find a place for pull ups : )

Eating on the go.  OK, so far so good, but how about food?  When traveling, think about food in terms of fuel, protein and produce.  Your fuel needs are minimal when you’re on a plane, car or boat, so don’t worry about it then.  I love using meal replacements like MediClear when traveling.  I’ll make up single servings in snack size baggies and mix them up in a water bottle.  Have 2-3 servings per day while en route.  This way you get a nutritionally complete low calorie meal and your body gets to rest and detox.  You’ll also drop a few pounds which may help you break even by the time you get home.  When you arrive, focus on soups as an easy way to get produce and protein without lots of fat or the risk food-borne illness.

The best defense being a good offense holds true for more than just football. A healthy diet full of cancer-fighting foods is a great offensive move to avoid cancer. I counsel patients to create an environment where cancer cannot grow by making these healthy food choices.

Fruits and vegetables

Brightly colored fruits and vegetables – Carotenoids have been shown in one study to reduce your risk of breast cancer by up to 50% in women with dense breast tissue. Dense breast tissue is one of the strongest risk factors associated with breast cancer.   Papaya contains the carotenoid beta-cryptoxanthin. Yellow and orange vegetables are high in beta-carotene, one of the most abundant carotenoids in our diet. Research illustrates that people who eat the most fruits and vegetables have the lowest breast cancer risk.

Cruciferous vegetables – Broccoli and cauliflower contain indole-3-carbinol, which promotes healthy estrogen metabolism. When estrogen leaves your body through unhealthy pathways, your risk of breast and other estrogen-fed cancers increases.

Good Fats

Walnuts – The journal Nutrition and Cancer recently published a study that shows walnuts slow the growth of breast cancer and may prevent its development. Rich in omega 3 fatty acids, these nuts have been shown to cause destruction (apoptosis) of cancer cells. Try walnut oil on your salads.

Fish – Good fatty fish like salmon is also rich in omega 3s. Studies suggest that women with higher levels of omega 3s in their diets have lower rates of breast cancer.

Olive oil – like walnuts, EVO oil is also high in omega 3s.

Get some flavor in your diet

Herbs and spices – According to the National Cancer Institute, a French study found a statistically significant reduction in breast cancer risk in women who consumed a lot of garlic. Oregano and thyme have antioxidant properties that inhibit tumor growth. Curcumin suppresses cancer cell growth.

Green tea – Buy quality stuff, not all green teas are created equal and you want to make sure that you are getting a good dose of the cancer-fighting compound EGCG.

Dark chocolate – Yum! Although dark chocolate does have sugar, it is also rich in antioxidants that reduce inflammation and suppress cancer cell growth. Please note that I am not referring to Hershey’s type dark chocolate, but to high quality organic varieties.

Things to avoid

Sugar – No cell in your body will consume sugar faster than a cancer cell. Sugar is very inflammatory and cancer thrives in an inflamed environment. Aside from the fact that sugar taste addictingly good, it has no redeeming value. This is one of the first things to remove from your diet, and once you do so, liking the taste disappears.

When my mother went through chemotherapy, she craved Coke and McDonald’s french fries. This stunned my brother and me because we did not grow up as a family that ate McDonald’s. Looking back I now realize the cravings were a die-off reaction from the cancer cells. As the chemotherapy weakened and destroyed them, the cancer cells caused my mom to crave the sugar and simple carbohydrates that were their primary fuel source.

Alcohol – According to a January 2011 study in the British Medical Journal, 5% of female breast cancer can be attributed to alcohol consumption. The upper limit for women is one drink, which contains about 12g of alcohol. The more alcohol consumed in excess of this limit, the greater your risk of breast cancer. If you are drinking red wine for the cancer-fighting properties of resveratrol, please take a pill or drink concord grape juice instead.

Charred meat – If you like your meat well-done or blackened, think again. The black is full of carcinogens and has been linked to many types of cancer. Lower your cancer risk by cooking meat enough to sufficiently kill bacteria without excess charring. If you do accidentally burn the meat, cut off the charred portion.

Check out these resources

Eattodefeat.org – The Angiogenesis Foundation has launched the Eat to Defeat Cancer campaign. The focus of this campaign is to eat foods that reduce the blood vessels that feed tumors. By depriving them of a fuel source, the tumor cannot grow. This website has teamed up with some top chefs to create recipes that contain cancer-fighting ingredients.

AICR – the American Institute for Cancer Research is a charity research organization that focuses on nutrition and exercise to reduce cancer risk. This group funded the study that showed walnuts help prevent breast cancer. Sign up for their newsletter to receive weekly healthy recipes.

“Let food be your medicine and medicine be your food.” – Hippocrates

If there is one thing women fear, it is breast cancer. Perhaps it is the fact that breasts are such a feminine attribute, strongly associated with attractiveness and fertility, that women associate breast cancer with a loss of sexuality and even a loss of self. Some women are afraid of the various treatment modalities such as surgery, chemotherapy and radiation. These treatments may cause pain, sickness, or physical changes such as hair loss and even breast loss. I have had many patients state they feel that the treatment is worse than the disease.

Everyone knows someone who has had it – family, friends, or coworkers. According to BreastCancer.org, 1 out of every 8 women will develop invasive breast cancer in their lifetime. And our risk of getting breast cancer increases as we age.

Many women do not go in for regular screening because they do not want to hear bad news. The idea is that “no news is good news.” But nothing could be further from the truth. Breast cancer, like most cancers, is completely treatable if caught early. Regular screening and follow up with your doctor is extremely important, but what can we do to prevent breast cancer?

Research shows that the way our bodies break down estrogen can increase our risk of breast cancer. Estrogen is metabolized in the liver and the metabolites, or byproducts of metabolism, are a key to developing breast cancer. There are six metabolites that we look at – four metabolites are considered “bad” and only two are considered “good”. And although all six metabolites may be present, it is the ratios of these metabolites to one another that are important. One of the most reviewed ratios is commonly called the 2:16 ratio. If this ratio is less than 2, meaning that you have too much of the bad estrogen (16) and not enough of the good estrogen (2), studies show that you are at an increased risk of breast cancer, as well as other estrogen driven cancers such as cervical cancer and ovarian cancer.

How can you find out how your liver is breaking down estrogen? A simple morning urine sample can be sent to the lab for evaluation to determine your estrogen metabolism ratios. Once we have that information, we can assess your risk and take steps to mitigate that risk. This test can also be used to monitor current treatment plans to reduce breast cancer risk, as well as to monitor hormone replacement therapy. It is a great test to determine a woman’s osteoporosis risk as well.

What can affect the balance of this ratio? Diet and exercise have a strong impact on the 2:16 ratio. Adding flax seeds, cruciferous vegetables, and soy products into your diet can increase this ratio. Likewise obesity and alcohol consumption can have a negative impact. Definitely kidney function and fluid consumption can affect this ratio so I recommend a basic CBC and CMP with the estrogen metabolism test. Your doctor will be able to interpret your labs, determine how you metabolize estrogen, and create a plan to shift your metabolism to a different pathway if necessary.

Mention the phrase “food allergies” and most of us imagine those poor kiddos who get near a peanut butter sandwich only to have massive swelling around the eyes and throat, followed by difficulty breathing and hives.  The constellation of these symptoms make up what’s known as an anaphylactic reaction which, unfortunately, has become more and more frequent in the general population over recent years.  In fact, some newer studies suggest that approximately 3-8% of Americans run the risk of anaphylaxis when exposed to any number of foods, although tree nuts, milk and shellfish are at the top of the anaphylactic list.

Even more, we are seeing a less severe variation of these dangerous food allergies, called “allergy sensitivities” that don’t typically cause life-threatening symptoms, but can still be quite uncomfortable nonetheless.  If you have symptoms like indigestion, gastritis, eczema, asthma, celiac disease, arthritis, and even depression, anxiety, and chronic fatigue, it could be a result of a “food sensitivity.”  Additional reports suggest that at least 60% of Americans suffer from symptoms due to adverse food reactions as a result of food sensitivities.

Food allergies/sensitivities may be a reaction to a protein, a starch, a contaminant found in the food (e.g., pesticide residues) or a food additive (e.g., colorings, preservatives, flavor enhancers, etc).  Once the body decides it’s uneasy with a food, a complex cascade of events takes place that can result in either a life-threatening situation (anaphylaxis) or simply the aforementioned unpleasant symptoms.

Driving this reaction is the immune system’s production of multiple types of antibodies.  For example, during an anaphylaxis response, IgE antibodies are produced within two hours of exposure.  These antibodies then bind to specific cells called mast cells and basophils which release their inner contents–histamine.  This is why an anti-histamine, like Benadryl or Quercetin, is often prescribed for allergies.

Yet, it’s the more delayed allergic response found in food sensitivities, one that can take up to 72-hours after exposure, that causes the aforementioned “uncomfortable” symptoms.  This response is usually driven by IgG antibodies and although it can stimulate the release of some histamine, it usually recruits many more players of the immune system, further complicating the reaction in the body.

Studies suggest that dairy, wheat and eggs are the three biggest sources of food sensitivities in people.  How is this determined?  In the past, the skin prick test was used where small amounts of foods were injected into the skin either on the back or forearm.  Now a simple blood test does away with this antiquated test.  These blood tests can measure for both IgG and IgE antibodies and help guide you and your provider in a direction for food avoidance, which is the mainstay of treatment.

So if you suffer from indigestion, asthma, eczema, etc., simply avoiding problematic foods could be your ticket to feeling well.  In addition to elimination, I recommend rotation of food families (e.g., veggies, fruits, meats, etc.) along with assisting the body with its normal digestive processes through the use of pancreatic and stomach enzymes.  Probiotics can be quite helpful as well.

Living in fear of foods because of their potential to make us sick is unnecessary when you recognize there are easy ways to identify possible sources of food allergies/sensitivities.  Combined with practical and realistic interventions you can take to calm the reaction and subsequent symptoms, you can alleviate a multitude of health conditions.

On the way in to the office this morning I dropped off my daughter at middle school and my son at elementary school.  Over the course of the drive I saw children, adolescents, teens, parents, cyclists, and workers all drinking what I call the ‘new soda’ – Gatorade.

There is a scary new disease identified as ‘Orthorexia Nervosa’.  It is a somewhat tongue-in-cheek attack on the elaborate web of food rules we find ourselves trapped in.  ‘Ortho’ refers to right or correct.  The ‘rexia’ is of course taken from anorexia, meaning suppressed appetite.  Interestingly the origin of anorexia is the same origin as the term rack, meaning to straighten.  We straighten our arms when we reach, therefore reaching became tied to appetite as in reaching for food.

Over the years I’ve heard so many versions of what to avoid.  If I avoided every food that I’ve ever been told to I would literally have nothing left except perhaps a few types of lettuce.  Oh, wait, the Chinese medical texts do recommend against raw vegetables.  OK, so cooked romaine.  That would get old fast.   We have to eat something.

Many current researchers and public health experts are realizing that telling someone not to eat something bad may be less productive than encouraging them to eat something good.  The best things to go out of our way to eat are the foods that give us the greatest benefits (number of important nutrients) for the least harm (calories).

Several authors have embraced the term ‘superfoods’ to describe certain foods that are especially high in nutrients and low in calories.  Although there is no formal list, some of the superfoods are tastier and more readily available than others.

Variety is certainly important in the diet, but with modern foods the idea of variety is misleading.  Rotating your morning Pop Tarts between cinnamon and cherry does not count as variety.  If you are talking about foods as great as the superfoods, don’t be afraid to find a few favorites and eat them everyday!

So why don’t we eat well?  The biggest concern I hear is that people don’t have time.  Between my family, practicing medicine, training and writing, believe me, I understand about time constraints.

The problem is that many have an idea of shopping daily and making every dish from scratch.  Mind you it’s a blast to spend a few hours puttering around in the kitchen, but that is not realistic for our workdays.  Bear in mind that anything you eat from wherever you get it will take some time.  If all of your meals are drive throughs, heaven forbid, you’ll still be spending at least 15 minutes per day just waiting in line.

Below are my top 20 easy to find superfoods.  Stay with me and I’ll show you how you can get most of these in a day with under 15 minutes of work, I promise!

1. Spinach
2. Broccoli
3. Blueberries
4. Carrots
5. Edamame
6. Black beans
7. Tomatoes
8. Turmeric
9. Grass-fed beef
10. Salmon
11. Mushrooms
12. Celery
13. Walnuts
14. Almonds
15. Greek yogurt
16. Avocado
17. Green tea
18. Pomegranate
19. Steel cut oats
20. Brown rice

When you wake up, make a 5 a day drink.  If you haven’t tried it yet, here’s the

videoon how to do it.    So far we’ve invested 3 minutes.

For breakfast, warm some pre-cooked steel cut oats from Sprouts or Whole Foods, just 1/4 cup if you’re watching your weight, add a dollop of non-fat plain Greek yogurt, some blueberries and a few almonds.  Now is also a good time for a cup of green or white tea.

So, 2 minutes to warm oatmeal and assemble, our tally is at 5 minutes.

Before you leave for work, pour together a nice salad.  Shop right and you’ll have zero prep work to do.

Mix into a large bowl:

• Washed spinach leaves
• 2-3 ounces smoked salmon
• Sliced mushrooms
• Prepped pomegranate seeds (you can now buy these already cleaned and separated!)
• Broccoli florets
• Black beans, canned – rinsed
• Walnuts, small handful
• 1 – 2 tbsp natural guacamole

The guacamole also works as a ‘dressing’ and flavoring for the salad.  This whole process should not take more than 2 minutes so we’re at 7 minutes.

For dinner, sauté some lean grass fed ground beef, add in Thai curry paste (Turmeric and lots of great flavor).  Stir in your favorite frozen mixed vegetable blend and serve over pre-cooked brown rice.  Have 1/4 cup of rice only if you’re watching your weight.  Allow 5 minutes for this and we’re at 12 minutes of cooking for the whole day and we ate every single superfood!  How awesome is that!

Many of my patients declare their soda consumption as safe by explaining how they “only drink diet soda, without any of that sugar,” while others state “I only drink regular soda, none of that diet stuff.”  Everyone seems to have the belief that one type of carbonated drink is healthier than another.  With so much information out there on the virtues of sweeteners, it is easy to justify your choice. So which is really better, regular or diet? Well, let’s compare and contrast the two.

Regular Soda Pros and Cons

Pros:  Tastes good.

Cons:  The sugar in regular soda causes your blood sugar levels to spike which can lead to insulin resistance, high cholesterol, high blood pressure, heart disease, diabetes, weight gain and premature aging.  Over time, soda can also erode tooth enamel and weaken your bones increasing your risk of osteoporosis.  It can also cause gastritis and acid reflux.

Hmm, that’s pretty heavily weighted on the negative side.  Let’s look at diet soda.

Diet Soda Pros and Cons

Pros:  Tastes good.

Cons:  Ok, diet soda won’t cause your blood sugar levels to spike and crash, but it does contain a lot of harmful chemicals including aspartame. The use of aspartame has increased to replace high fructose corn syrup (HFCS). Like HFCS, aspartame can have many negative effects on all parts of your body.  Neurologically, aspartame can lead to migraine headaches, memory loss, seizures and numbness and tingling in your arms and legs.  Psychiatrically, aspartame may cause depression, anxiety, irritability and aggression.  Your digestive tract will also suffer the consequences of aspartame by causing nausea, vomiting, diarrhea and abdominal pain.  As if these reasons weren’t enough to turn you off of diet soda, it may also cause weight gain, blindness, tinnitus, PMS, thinning of hair and menstrual changes.  And it, too, erodes tooth enamel and weakens your bones.

It looks like we have a tie and no winner.  Both diet soda and regular soda are equally bad for us.

Is it ever good to drink soda?

Yes, if you are stranded in the desert with no other source of hydration, you should drink soda to stay alive. But, short of that or a similar scenario, it is a bad idea to pour all of that sugar and chemicals into your body, especially when there are numerous healthy choices available.

What can I drink that tastes good and will quench my thirst?

First and foremost, learn to love water!  I am always amazed at the number of patients who tell me that they cannot stand the taste of water.  If you fall into this category, try cutting up a piece of fresh produce like lemon, lime, strawberry, cucumber, or mint leaves and put it into a pitcher of ice water. This is a healthy way to add a mild flavor to the water and make it more palatable.  If that’s not enough flavor enhancement for you, Capella and Yum Drops make naturally flavored drops for your water with the good sweetener Stevia. Give them a try, you might love water again.

What should I do with all of my leftover soda?

Apparently it actually can be used to remove corrosive acid off a car battery – diet or regular soda.  Can you see what it does to your body now?  Kick the soda habit, you’ll be happy you did!

By now most of you have read or heard directly from me about my bicycle crash two weeks ago.  I’ve been overwhelmed by the deluge of positive thoughts, emails, cards and well-wishes from everyone.  For those of you who missed the story, I shattered my collarbone into six pieces two weeks ago following a crash during a Saturday century ride.  This photo is right after the crash as my ride-mates loaded my broken bike into the car before my ER visit.  Thirteen screws later, the bone is back into one “piece” and the pain is improving everyday.  With my doctor/patient roles reversed and this being my first broken bone and surgical procedure, it’s been an emotionally eye-opening educational experience for me.  The constant pain and the mental lows lead to my inability to perform my daily work and home responsibilities requiring major adjustments.  No fun.

Yet with the help of my wife, I made some powerful insights that have been invaluable to me and, I believe, to my future practice with my patients.  Maintaining good physical and mental strength through a medical challenge can be, well, challenging.  But with all my down time (I felt like I visited every website ever created) I was able to pour over the research and I think I’ve discovered three approaches that seem to apply to nearly anyone with any difficult medical situation.  If you can implement these three tenets, you should be able to overcome most challenges.  They are:  1) keep moving, 2) monitor your daily progress, and 3) design a healthy environment.

There’s a lot to consider in those three tenets and that last one may sound intimidating, but I promise, they’re all very simple.  First, keep moving.  Our bodies are designed to stay in motion.  In no other time during our history as humans on this planet have we been able to survive through our daily routines with so little physical movement.  From desk jobs to nearly limitless access to goods and services, we physically work much less than we should.  Most studies suggest as little as 30-minutes of dedicated briskly-paced walking can do the trick although upwards of 60-minutes a day is even better.  Even with my busted shoulder, I made it a point to keep moving with walks around the neighborhood to waist-deep plunges in the pool.  Make it a point to move around and your body will thank you for it.

Next, monitoring daily progress.  With half of 2011 already over, you too might see how easy it is to let the days slip by without recognizing both positive and negative changes you make to your lifestyle.  There is nothing more powerful than frequently tracking your progress throughout each day in order to take control of your lifestyle.  I constantly recommend to patients “Diet Diaries,” or writing down everything you eat and drink, along with fitness achievements.  Studies have shown time and time again that this simple approach is more effective than any other strategy at evaluating and modifying basic lifestyle behaviors. With my collarbone, I measured the angles surrounding my shoulder’s range of motion daily, along with slow but daily additions of gentle strengthening exercises.  Sprinkle on multiple cryosauna applications and my surgeon, during a recent follow-up visit, couldn’t believe my progress in two short weeks.

Third, create an environment that is conducive to better health. Surround yourself with positive influences like people who have healthy lifestyles–studies show it will motivate you to do the same.  Think of it as a healthy dose of peer pressure.  Also, build into your daily routine healthy food choices at home and work that are readily accessible. More specifically, if healthy food choices are not easily available at home, when you’re hungry, your concept of what’s healthy quickly becomes skewed.  In addition, when it comes to a healthy diet, use smaller plates (which decreases portion-sizes), serve yourself a healthy portion and then store left overs before eating.  One last strategy I discovered is to consider eating in front of a mirror, which seems weird, I know, but a great German study last year showed it dramatically decreased the amount of calories test subjects ate.  You have incredible control over the environment in which you live.  Take the time to make it conducive to better health.

Finally, after doing all that you can to implement the first three tenets, be sure to be kind to yourself.  Don’t be hard on yourself if you have a tough day and “fall off the wagon.”  Studies show that the stress hormones released as a result of this added pressure on yourself is much more harmful than simply moving back to your healthy baseline. Life isn’t about being perfect.  Do the best you can, strive for your best, but allow yourself to recover from expected and unexpected setbacks.  On the day of my crash I was in great physical shape through great strides I had made during my training.  Instantly I was forced to “slow things down” and quickly have lost my physical stamina.  But, by taking proactive and preventative steps now, including the above ideas, my recovery has been relatively quick.

A major health issue can very quickly derail you from a healthy lifestyle.  But by following the above three tenets, you can regain control of your health, your surrounding environment and treat yourself better than you ever have before.